分裂型右肝管合并结石及狭窄的手术处理

Surgical treatment of splitting right hepatic duct with hepatolithiasis and stenosis

目的 探讨分裂型右肝管合并结石及狭窄的手术治疗方法。方法 回顾性分析 11年间手术治疗的 3 8例分裂型右肝管合并结石及狭窄患者的临床资料。结果 全组均行手术治疗。手术方式包括 :( 1)分裂型右肝管开口原位整形术 7例 ;( 2 )分裂型右肝管与相邻肝管开窗术 9例 ;( 3 )分裂型右肝管与相邻胆管合干成形术 8例 ;( 4 )分裂型右肝管相应肝叶、段切除术 14例。 6例发生术后并发症 ,经非手术治疗治愈 ,无围手术期死亡。所有患者随访 5～ 16年 (平均 9.2年 ) ,残留结石率2 6.3 % ,疗效优良率 78.9%。结论 准确的定位诊断和合理的手术方法治疗分裂型右肝管合并结石及狭窄可获得较满意的结果。

Objective To evaluate the surgical treatment of splitting right hepatic duct with hepatolithiasis and stenosis. Methods The clinical data of 38 patients with splitting right hepatic duct and hepatolithiasis treated by operation were analyzed retrospectively. Results All the patients underwent operation. operative procedures were as follows: (1) in situ cholangioplasty of splitting right hepatic duct in 7 cases;(2) fenestration of splitting right hepatic with adjacent hepatic duct in 9 cases; (3) bilioplasty of splitting right hepatic duct with adjacent bile duct in 8 cases; (4) hepatic lobectomy or segmentectomy of splitting right hepatic duct in 14 cases. Postoperative complications developed in 6 cases, which were cured conservatively. There was no perioperative mortality. All patients were followed up for 5～16 years(averaged 9.2 years). Excellent rate was 78.9%,and residual stones were found in 26.3% of the patients . Conclusions Accurate localization and appropriate operation may get satisfactory result in treating patients with splitting right hepatic duct with hepatolithiasis and stenosis.